The sudden, tragic death of Sheryl Wolfe from a massive stroke at age 18 is cause to ask questions about the prevalence of stroke among teens and young adults and possible causes. Ms. Wolfe, who was recently crowned Miss Hawaii Teen United States, had no history of health problems or family history of stroke, according to news reports. What happened to Sheryl could happen to other young people as well.
The New York Daily News reported that the teen probably had a blood vessel abnormality, according to Dr. Steven Wolf, director of pediatric neurology at St. Luke’s and Roosevelt hospitals. Sheryl collapsed while sitting in class at her high school and was in a coma for one week.
One possible cause of stroke is an aneurysm (a blood-filled dilation of the blood vessel wall) or an AVM (arteriovenous malformation), an abnormal accumulation of blood vessels that can bleed and exert pressure on other vessels. In some individuals, an aneurysm or AVM does not give a warning and just erupts.
The American Heart Association reports that the risk of stroke among children up to age 18 is nearly 11 per 100,000 children per year. The most common underlying risk factors are sickle cell disease and congenital or acquired heart disease. Other risk factors for stroke in young people include head and neck infections, systemic conditions such as inflammatory bowel disease and autoimmune disorders, head trauma, dehydration, maternal history of infertility, maternal preeclampsia, and material infection in the amniotic fluid.
Some of the risk factors for stroke among young people may also include some of those seen for older people, including obesity, high blood pressure, diabetes, and high cholesterol. The American Heart Association reports that about 3,000 children and young adults die of stroke each year in the United States.
A new study just published in Stroke adds hyperthyroidism to the list of risk factors for stroke among young people. According to Herng-Ching Lin, PhD, senior author of the study and professor at Taipei Medical University in Taipei, Taiwan, “strokes of undetermined cause account for between one-third and one-fourth of all ischemic strokes in young people.”
Lin went on to note that “To the best of our knowledge, hyperthyroidism has never been considered as a potential risk factor for stroke in the 18 to 44 age group.” The researchers found that hyperthyroidism at a young age was associated with a 44 percent increased risk of stroke.
A study published in Cerebrovascular Diseases in 2004 looked at the causes and risk factors for stroke in 273 young people ages 16 to 49 and found that the cause of stroke was unknown in 24 percent of the cases. In the other 76 percent, a cardiovascular condition was the cause, including large-vessel and small-vessel disease, and vasculitis.
Migraine is also associated with stroke in young people, especially young women. In a 2007 study published in Stroke, investigators studied 386 women ages 15 to 49 with first ischemic stroke and 614 controls. Women who had probable migraine with visual aura had 1.5 greater odds of having an ischemic stroke, and the risk was highest among those who had no history of hypertension, diabetes, or myocardial infarction compared with women who had no migraine. Women who had experience onset of migraine within the previous year had 6.9-fold higher odds of stroke compared with women without a history of migraine.
Stroke in young people is not a common occurrence, but it is a tragic one. Between 20 and 40 percent of young people die as the result of a stroke, and up to 80 percent experience permanent neurological deficits. Sheryl Wolfe was an unfortunate victim of stroke at a young age, but she passed along the gift of life via her organs to four individuals.
American Heart Association
Cerrato P et al. Cerebrovascular Diseases 2004; 18(2): 154-59
MacClellan LR et al. Stroke 2007 Sep; 38(9) 2438-45
New York Daily News, April 21, 2010
Sheu JJ et al. Stroke 2010 April 1